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PolicyGuidelineTitle: Declaration of Life Extinct by Registered Nurses andMidwives in the Absence of a Medical Practitioner.Objective file number: 2009-10988Policy developed by: Public Health and Clinical Coordination DivisionApproved at Portfolio Executive on: 16 September 2010Next review due: 30 September 2015SummaryKeywordsPolicy historyApplies toStaff impactThis Declaration of Life Extinct by Registered Nurses andMidwives in the Absence of a Medical Practitioner Guideline is forthe assessment and declaration of life extinct by registerednurses and midwives in the absence of a medical practitionerwhere patients die in a hospital, health centre, nursing home,hostel or at home.Declaration Life Extinct, Certification death, AssessmentExtinction LifeIs this a new policy? YDoes this policy amend or update an existing policy? NDoes this policy replace an existing policy? NAll Health RegionsAHS, CYWHS, Country Health SA, SAASManagement, Admin, Medical, Nursing and MidwiferyPDS referenceG0097Version control and change historyVersion Date from Date to Amendment1.0 10/09/2010 30/09/2015 Original version© Department of Health, Government of South Australia. All rights reserved.

1. Policy.This guideline is for the assessment and declaration of life extinct byregistered nurses and midwives in the absence of a medical practitionerwhere patients die in a hospital, health centre, nursing home, hostel or athome.This guideline will be used by public sector hospitals and health centres(incorporated under the South Australian Health Care Act 2008) and does notnegate the need for certification of death to be undertaken by a medicalpractitioner.2. Background.Following significant consultation the guideline was developed which will allowregistered nurses and midwives to declare the extinction of life in the absenceof a medical practitioner.Associated Policies/Procedures/Standards/InstructionsBirths, Deaths and Marriages Act 1996Births, Deaths and Marriages Registration Regulations 1996Clinical Practice Manual, Declaration of Life Extinct, South AustralianAmbulance Service Intensive Care Paramedics, May 2005South Australian Ambulance Service Clinical Communication, IssuesAssociated with Resuscitation, Issue No 28/04, Date of Issue 23 April 2004Coroners Act 20033. Scope.Assessment of the Extinction of Life and Certification of DeathThere is a very distinct difference between the assessment of the extinctionof life and the certification of death.Assessment of the extinction of life: A clinical assessment process isundertaken to establish that life is extinct. By evaluating cardiac output,neurological signs and respiratory status, using a standard regime of clinicalassessment tools a registered medical practitioner or registered nurse ormidwife can generally establish that life is extinct. The clinical assessmentincludes assessing the absence of pulse, heart sounds, respiratory effort andpupillary response, movement or any other signs of life for at least oneminute.Declaration of life extinct: Life extinct is declared following the assessmentof the extinction of life. It is the recording of a set of clinical observations, thatincludes the absence of pulse, heart sounds, respiratory effort and pupillaryresponse, movement or any other signs of life for at least one minuteCertification of death: The Births, Deaths and Marriages Registration Act1996 states that the certification of death is only to be undertaken by amedical practitioner.

The certification of death is the process by which the time, specific details andcauses of death are reported by a medical practitioner. Certification of thefacts and the causes of death must be reported by a medical practitioner tothe Registrar, Births Deaths and Marriages in accordance with section 36 ofthe Births, Deaths and Marriages Registration Act 1996 within 48 hours ofdeath.A doctor must not give a notice under this Section if the State Coroner or apolice officer is required to be notified of the death under the Coroners Act2003.Implementation of the Guideline Enabling Registered Nurses andMidwives to Declare Life Extinct in the Absence of a Medical Practitioner1. The assessment of the extinction of life and the certification of deathmust be recognised as being two separate procedures or processes.2. The guideline does not detract from the legislative requirements of theBirths, Deaths and Marriages Registration Act 1996 and the Coroners Act2003.3. In a hospital or health centres where there is a medical practitioneravailable on site, the medical practitioner has the responsibility forassessment of, or confirmation of, the extinction of life (this is usually doneat the same time as certifying death).Nurses and midwives are not to declare life extinct when it is reasonablefor a medical practitioner to attend and perform the function.4. In some circumstance (e.g. hot weather or where a medical practitioner’sattendance involves long delays) appropriate management of the bodymay involve the removal of the body to a morgue or holding room andsometimes, refrigeration of the body. Preservation of the body is importantat this time until decisions are made regarding the contacting of relatives,post mortem examination and funeral arrangements.5. The guideline addresses the situation where a medical practitioner is notavailable on site 1 . In these circumstances, unless the need to attend isurgent, or the cause of death is unclear, or there is uncertainty as towhether life is extinct, or medical tests need to be undertaken topronounce life extinct (e.g. brain death) or the registered nurse or midwifeotherwise considers it necessary for a medical practitioner to attend, aregistered nurse or midwife may perform the normal role of assessing theextinction of life and managing the body appropriately prior to a medicalpractitioner certifying death.A registered nurse or midwife assessing the extinction of life shall make afull report of the assessment (including the time of assessment) in thedeceased person’s health care record.6. Where the death is a Coroner’s case and there is no medical practitioneravailable to attend the deceased, a registered nurse or midwife mayassess the extinction of life and give preliminary notification of the death tothe police. The considerations in paragraph 4 above as to whether a1 Described as where there is no medical practitioner available on site and has no capacity toattend.

egistered nurse or midwife should undertake the assessment also apply inthis situation. Once initial notification has been made, a medicalpractitioner would be required to fulfil other notification requirements underthe Coroners Act 2003.7. Candidates for tissue/organ donation are not suitable for assessment ofextinction of life by a registered nurse or midwife due to the requirementsfor certification of brain death.8. Where a client is known to a hospital and health centre and has beenunder the care of that service for the purposes of palliative care, aregistered nurse or midwife, in the absence of an available medicalpractitioner or where a medical practitioner may be unable to attend for along period of time, may assess the extinction of life. In this instance,paragraphs 1, 2, 5, 6 and 7 above would apply.9. Where it is possible for a medical practitioner to attend the deceased in atimely manner, the medical practitioner should assess, or confirm theextinction of life and certify death at the same time.Please see attached flow charts to assist in outlining the processes.4. Responsibility.This guideline must be used by hospitals and health centres incorporatedunder the South Australian Health Care Act and all health professionalsshould be aware of this policy.5. Risks.Non-compliance with this guideline may compromise internal control anddocumentation requirements resulting in inappropriate, unauthorisedmanagement of the assessment and declaration of life extinct by registerednurses and midwives in the absence of a medical practitioner where patientsdie in hospital, health centre, nursing home, hostel or at home.6. Definitions.Assessment of the extinction of life: a clinical assessment process isundertaken to establish that life is extinct. By evaluating cardiac output,neurological signs and respiratory status, using a standard regime of clinicalassessment tools a registered medical practitioner or registered nurse ormidwife can generally establish that life is extinct.The clinical assessment includes assessing the absence of pulse, heartsounds, respiratory effort and pupillary response, movement or any othersigns of life for at least one minute.Certification of death: is the process by which the time, specific details andcauses of death are reported.A medical practitioner has a legal obligation under Section 36 of the Births,Deaths and Marriages Registration Act 1996 to certify death within 48 hoursafter the death.

Declaration of life extinct: life extinct is declared following the assessmentof the extinction of life. It is the recording of a set of clinical observations, thatincludes the absence of pulse, heart sounds, respiratory effort and pupillaryresponse, movement or any other signs of life for at least one minuteMedical practitioner: a person who is qualified (registered on the generalregister or on both the general and specialist registers) to diagnosis physicaland mental illness, disorders and injuries, and prescribe medications andtreatment to promote good health.Medical practitioner is not available: is described as where there is nomedical practitioner available on site and that no medical practitioner has thecapacity to attend.Midwife: is a person who is registered under the Health PractitionerRegulation National Law. Midwifery is a regulated profession thereforemidwives are accountable to the public for providing the highest standard ofcare by maintaining the highest professional standards of competence andconduct in midwifery. A midwife is a professional who, in partnership with thewoman, provides care, education and support during the childbearing cycle.Registered nurse: is a person who is registered under the Health PractitionerRegulation National Law. A registered nurse is authorised to practise withoutsupervision and is accountable and responsible for the provision of nursingcare. The registered nurse is further accountable for assessment anddecisions in relation to delegation and supervision (both direct and indirect) toenrolled nurses. The registered nurse cannot delegate this accountability).Moribund: is a person who is dying or is at the point of death.

Assessment of the Extinction of Life and Certification of Death inHospitals, Health Centres, Aged Care Facilities or Home1.1 Where a Medical Practitioner is AvailablePerson found moribundOn assessment by the registerednurse or midwife, life appears to beextinctNotify medical practitionerPossible Coroner’s Case or cause ofdeath uncertainNOYESMedical practitioner toexamine body and topronounce life extinct andreport death to policeand/or coronerPossible Tissue/Organ DonorYESRegistered nurse ormidwife to notify Eye Bankon 8378 1111 pager 6033NOMedical practitioner to confirmextinction of life and issueCertification of DeathMedical practitioner MUSTpronounce life extinct priorto tissue/organ retrievaloccurringDeceased to be prepared andtransferred to mortuary

Assessment of the Extinction of Life and Certification of Death inHospitals, Health Centres, Aged Care Facilities or Home1.2 Where a Medical Practitioner is NOT AvailablePerson found moribundOn assessment by the registerednurse or midwife, life appears to beextinctNotify medical practitioner -document all attempts and outcomesof attempts to notify medicalpractitionerPossible Coroner’s Case or cause ofdeath uncertain and/or unexpectedNOYESA registered nurse ormidwife may assess theextinction of life, and givepreliminary notification ofthe death to the policePossible Tissue/Organ DonorYESRegistered nurse ormidwife to notify Eye Bankon 8378 1111 pager 6033NOMedical practitioner MUSTpronounce life extinct priorto tissue/organ retrievaloccurringRegistered nurse or midwife toperform clinical assessment todeclare life extinctRegistered nurse or midwife toclearly document time and details ofassessment and declaration in clienthealth recordDeceased to be prepared andtransferred to mortuaryMedical practitioner to be notifiedand to certify death as soon aspossible